Even weight at high end of normal ups children’s risk for hypertension
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Key takeaways:
- The risk for developing hypertension in 5 years was 26% higher for children at the high end of average weight range, compared with peers in the medium range.
- Every BMI unit gained per year increases a child’s risk for hypertension by 4%.
- Hypertension rates were higher among boys and children on state-subsidized health plans.
A large-scale study found that the risk for developing hypertension within 5 years was higher even among children who were at the high end of normal weight, according to findings published in JAMA Network Open.
“Obesity has been discussed as the main driver for pediatric hypertension for several years,” Poornima Kunani, MD, a pediatrician and researcher at the Kaiser Permanente Manhattan Beach Medical Office and regional lead for pediatric weight management at Kaiser Permanente Southern California, told Healio.
“In general,” Kunani said, “there is a lack of evidence in the literature regarding pediatric obesity and its related comorbidities, and how children chart across the years in terms of the relationship to BMI. We thought we'd start our journey by examining the relationship, or rather the longitudinal relationship of BMI and blood pressure.”
Kunani and colleagues examined data on 801,019 patients aged 3 to 17 years who received care from Kaiser Permanente Southern California between 2008 and 2015. They divided participants by average body weight into low (5th to 39th percentile), medium (40th to 59th percentile) and high (60th to 84th percentile) groups. They also divided them by blood pressure, using various definitions for stage I and II hypertension depending on their age.
The researchers identified 24,969 youths with incident hypertension, with the paramount finding being an increased risk for hypertension among children who fell under a high — but not obese — body weight for their age.
Specifically, children whose baseline body weight was in the 60th to 84th percentiles of BMI — what the researchers deemed the “upper range of normal” — were at an increased risk for hypertension compared with children in the 40th and 59th percentiles of BMI, “with a 26% higher risk of hypertension if their body weight remained stable during follow-up,” they wrote.
“We definitely did not expect to see the increased risk of hypertension to be so close to what we consider normal BMI, which is right under the 85th percentile for children,” Kunani said.
Hypertension incidences per 1,000 person-years were also higher among boys (8.49; 95% CI, 8.36-8.63) compared with girls (5.52; 95% CI, 5.42-5.63), youths with a state-subsidized health plan (7.91; 95% CI, 7.72-8.11) compared with those without (6.7; 95% CI, 6.61-6.8) and highest among white (7.2; 95% CI, 7.02-7.38) and Hispanic youths (7.19; 95% CI, 7.08-7.32) compared with other youths (IRs ranged from 5.71 to 6.4).
Kunani said she was “in agreement” with an AAP clinical practice guideline that encourages practitioners to measure a child’s blood pressure at least annually, beginning at age 3 years.
“But our study also underscores the need for medical professionals to perhaps reevaluate how we correlate risk and how we educate families regarding health risk behaviors across the spectrum of weight,” Kunani said.
She noted that in the future, she would like to examine “what is conferring the high risk to these children.”
“Is it central adiposity? Is that genetics? Is it nutrition? What exactly is elevating the risk factor?” Kunani said.